You'll find hundreds of files on cleft lip, cleft palate here on widesmiles.org.

This one is about: Pierre Robin, Pharyngeal Flap & Obstructive Sleep Apnea

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Pierre Robin, Pharyngeal Flap and Obstructive Sleep apnea
 
(Sent to cleft-talk)
 
I just received in the mail today a copy of a study entitled: ROBIN SEQUENCE: OBSTRUCTIVE SLEEP APNEA FOLLOWING PHARYNGEAL FLAP

This was an ongoing 15 year study (1980-1995) conducted by a cleft surgeon from Boston Children's Hospital and the speech therapist on his team. The initial palate repairs were not all performed by him. The study is 4 pages long and very detailed, so I will only relay some of the information.

151 patients with the diagnosis of Robin sequence (RS) underwent cleft palate repair. All cleft repairs were performed between the ages of 8 and 14 months old.

In the study they further divided the RS kids into 2 groups: syndromic (sticklers and VCFS) and the nonsyndromic RS.

From the 151 kids, only 37 were nonsyndromic. 114 were syndromic.

They study focused on the occurrence of Obstructive sleep apnea in the Non syndromic PRS children after having a pharyngeal flap.

These were the findings:

Out of the non syndromic PRS children who received a pharyngeal flap to correct Velo Pharyngeal dysfunction - 86% developed Obstructive Sleep Apnea and had to have the flap taken down.

Out of the syndromic PRS children who received a pharyngeal flap to correct VPD - 95% developed Obstructive Sleep Apnea.

Quoting: "Conclusion: Since conventional pharyngeal flap for VPD in nonsyndromic Robin Sequence children resulted in a high incidence of obstructive sleep apnea, alternative management should be considered: modification of the standard pharyngeal flap, palateal lengthening (V-Y or double-opposing Z-plasty), or construction of a speech bulb."

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There is a lot more to the study and a lot of very interesting findings. One of those findings is the belief that one third of PRS children have Sticklers.

There is some good information about alternative procedures to help with VPD; the success rates of sphincter pharyngoplasty (80-85%). There is also a section describing when a Furlow technique (double opposing Z-plasty) may be a successful alternative.

"Another surgical option is a modified pharyngeal flap (short sandwich type) based more superiorly to prevent circumferential contraction, as described by the Montefiore 'cleft' unit (Shprintzen, 1988) He reported a 0% incidence of OSA following such a modified pharyngeal flap and careful postoperative management."

The study also discusses the pro's and con's of a prosthesis called a speech bulb.

I am certainly not sending this information to scare anyone. I am only sharing this so that those with PRS will have some "heavy duty" questions to ask their PS's if a pharyngeal flap is suggested.


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